The
collection is prefaced and named for a poem by Walt Whitman, The Wound Dresser,
annotated in this database by Jack Coulehan. In “On Reading Walt Whitman’s ‘The Wound Dresser’” Coulehan sees Whitman as a nurse
tending the Civil War wounded, and, while using some of the words and language
of Whitman’s poem, imagines himself moving forward in that created space of
caring for patients: “You remain / tinkering at your soldier’s side, as I step
/ to the next cot and the cot after that.” (p. ix) The poem introduces us to
all the ‘cots’ of the book – where we step from patient to patient, through
history and geography, and through the journey of medical training.
The
book is comprised of 4 sections without overt explanation, although there are 4
pages of Notes at the end of the book with information about select individual
poems. In general, the themes of the sections can be described as: 1.) clinical
care of individual patients and medical training; 2.) reflections on historical
medical cases, reported anecdotes or past literary references; 3.) meditations
on geographically distinct episodes – either places of travel or news items;
and 4.) family memoir, personal history and the passage of time.
Many
of the poems have been previously published and a few are revised from an
earlier chapbook. Notable among the latter is “McGonigle’s Foot” (pp 42-3) from
section 2, wherein an event in Philadelphia, 1862 – well after the successful
public demonstration of anesthesia was reported and the practice widely
disseminated, a drunk Irishman was deemed unworthy of receiving an anesthetic.
Although it is easy to look back and critique past prejudices, Coulehan’s poem
teaches us to examine current prejudices, bias and discrimination in the
provision of healthcare choices, pain relief and access to care.
There
are many gems in these 72 poems. Coulehan has an acute sensibility about the
variety of human conditions he has the privilege to encounter in medical
training and clinical practice. However, one of the standouts for me was “Cesium
137” based on a news report of children finding an abandoned radiotherapy
source (cesium) in Goiania Brazil, playing with the glowing find and suffering
acute radiation poisoning. He writes: “the cairn of their small lives / burst
open…their bodies vacillate and weaken / hour by hour, consumed by innocence /
and radiant desire.” (p. 68).
Following
another poem inspired by Whitman, Coulehan concludes the collection with a
sonnet “Retrospective.” He chronicles a 40-year career along with physical
aging, memories of medical training “etched in myelin,” and the search for
connection across that span of career including, “those he hurt, the woman / he
killed with morphine, more than a few he saved.” Ultimately, he relies on hope
with fitting understatement: “His ally, hope, will have to do.” (p. 97)

In this painting, Edvard Munch shows, as the center of attention, a stricken young girl, propped on a thick white pillow, covered with a heavy blanket, at the end of her short life. A grieving companion sits next to her, her head so deeply bowed that we can only see the top of her head, not her features. The companion is so overcome with grief that she can neither hold her head up, nor look at the dying girl. Only the young girl's haunting profile is visible, as she looks steadily toward a dark ominous drape, perhaps representing the unknown or the mystery of death. Her reddish hair appears thin, damp, and uncombed against the pillow.The two figures make contact by holding hands for comfort. The artist omits the details of fingers, and just indicates a simple connected shape for both hands. Striving for only simplified and essential forms, Munch enhanced each surface by impassioned brushstrokes, nuanced colors, and thick layers of impasto paint.

Edvard
Munch’s painting, The Sick Child, hanging in the Tate in London, England is his fourth version of the painting. This version is done in oil on canvas and was
completed in 1907. The first version was painted in 1885. As
we come upon this painting, we quickly realize we are standing at the end of a
bed intruding upon a poignant moment. In this impressionistic painting, we can
discern an adolescent girl propped up in bed. She is facing an older woman
sitting at her side. We don’t see this woman’s face because her chin is on her
chest in a way that makes her look distraught. We can easily conclude that she
is the girl’s
mother and that the girl is sick, very sick.

When we look around the room with the view Munch gives us, we see little in the way of medical
supplies or equipment. There is only a bottle on a nightstand that might be
some potion and a glass of water on a dresser. Nothing more is to be done for
this child. She seems to know it and so she tries to comfort the woman who
is attending her. The painting reminds the viewer that often those who are dying offer comfort to the ones attending them as well.

Kenan Oak returns from World War I to a
small Ontario town. He is virtually unable to speak and dares not venture from
his home. Adopted by a reclusive uncle at an early age, he has no immediate
family but his wife, Tressa, who loves him and accepts his disability with good
grace. They have been trying to have a
child without success, and the glimmers of Kenan’s recovery are dauntingly few
and faint. Slowly with the help of his uncle Am, he begins to go out at night for
walks in the woods and skating on the ice of the lake.

Am and his wife Maggie have a strained
marriage. She loves to sing and once aspired to a career in music, but instead
she opted for Am and a farm—although now they live in town. Lukas, a gifted new
musician arrives to direct the choir; he is a postwar immigrant from an unnamed
European country, possibly Germany. He notices her talent and encourages her to
sing solo at the upcoming New Year’s concert. Unused to the attention, she is
captivated by him, his mystique, his appreciation of her, and the return of joy
through song. They have an affair, which is discovered by Am.
Well into the story, it emerges that Am and
Maggie had lost two children to diphtheria, and this trauma is at the heart of
their marital strife. It is why they left their farm and have grown apart. But Maggie imposed an edict of silence on this
exquisitely painful past. In contrast, Tressa slowly encourages her silent
husband to tell—by inventing stories
for him and letting him revise. His
adoptive uncle gives him a postage-stamp sized photograph of his nameless mother
and grandmother; together they construct a story.

Maggie falls pregnant with Lukas’s baby.
She goes away to have the child but Am cannot accept it. Compounding Maggie’s woe,
she stays with Am—for all their strife, they are bound in their loss. She allows
Tressa and Kenan to adopt her beloved baby.

Frank
Drum, 13, and his younger brother Jake are catapulted into adulthood the summer
of 1961 in their small Minnesota town as they become involved in investigation
of a series of violent deaths. Their
father, a Methodist minister, and their mother, a singer and musician, can’t
protect them from knowing more than children perhaps should know about suicide,
mental illness, and unprovoked violence.
The story is Frank’s retrospective, 40 years later, on that summer and
its lasting impact on their family, including what he and his brother learned
about the complicated ways people are driven to violence and the equally
complicated range of ways people respond to violence and loss—grief, anger, depression,
and sometimes slow and discerning forgiveness.

“Tithonus” is a dramatic monologue that imagines the once
handsome, magnificent Trojan prince to be well-advanced in an unfortunate state
brought about by negligent gods and his own lack of foresight. Exultant over the blessings of his youth,
he’d asked Aurora, goddess of the dawn, for eternal life, and she had obtained
Zeus’s permission to grant the request.
But Tithonus had failed to ask for eternal youth with his immortality—and
neither Aurora nor Zeus had managed to recognize that this feature of the
request might be important—so that Tithonus spends eternity growing
increasingly decrepit. In Tennyson’s
poem, Tithonus addresses Aurora, hoping he might persuade her to reassign him
his mortal status and allow him to die.

Samuel Shem's (Stephen Bergman) The House of God, first published in 1978, has sold over two million copies in over 50 countries (see annotation). Its 30th anniversary was marked by publication of Return to The House of God: Medical Resident Education 1978-2008, a collection of essays offering historical perspectives of residency education, philosophical perspectives, literary criticism, and women's perspectives, among others. Contributors include such well-known scholars as Kenneth Ludmerer, Howard Brody, and Anne Hudson Jones, as well as physician-writers Perri Klass, Abigal Zuger, Susan Onthank Mates, and Jack Coulehan. The closing section, "Comments from the House of Shem," includes an essay by psychologist and scholar Janet Surrey (Bergman's wife) and one by "both" Samuel Shem and Stephen Bergman.

The story
of The Heart is a simple, linear
structure. A car accident renders a
young Frenchman, Simon, brain-dead. A medical team proposes harvesting organs,
and his parents, after some turmoil, agree. That’s the first half of the book,
the provenance of this specific heart. The second half describes its delivery
for transplantation. Administrators find recipients, one of them a woman in
Paris. Simon’s heart is transported there by plane and sewn into her chest. All
this in 24 hours. The narration
is complex, with flashbacks, overlapping times, and literary art that is
compelling. There are 28 sections to the story but without numbers or chapter
headings, and these are often broken up into half a dozen shorter sections. We
have an impression of stroboscopic flashes on the action, with high intensity
focus. These create a mosaic that we assemble into dramatic pictures. Even
major characters arrive without names, and we soon figure them out.

Simon. He’s called
the donor, although he had no choice in the matter. At 19 years of age he’s
trying to find a path in life. A Maori
tattoo is a symbol for that search. He has a girlfriend, Juliette. He fades
away as a character (except in others’ memories) and his heart takes center
stage.
Marianne and Sean, Simon’s parents. Her emotions, as we would expect, range
widely, especially during discussion of whether Simon’s organs can be
transplanted. Father Sean has a Polynesian origin and cultural heritage.

Pierre Révol, Thomas Rémige, and Cordélia Owl are respectively
the ICU physician, nurse, and the transplant coordinator. These are vividly
drawn, with unusual qualities. Skilled professionals, they are the team the
supplies the heart.

Marthe Carrare, Claire Méjan, and Virgilio Breva are a
national administrator, the recipient, and a surgeon. Described in memorable
language, they are the receiving team.

The
characters’ names give hints of de Kerangal’s range. Since the 1789 Revolution Marianne has been a well-known French
national symbol for common people and democracy, but Virgilio
Breva is from Italy and Cordélia (recalling King Lear) Owl (as in wise?) has a grandmother from Bristol, England.
We learn of personal habits regarding tobacco, peyote, sex, and singing.
Medicine is part of a larger world of people of many sorts.

Even minor characters,
such as Simon’s girlfriend Juliette and other medical personnel are touching
and memorable.

These characters
animate the story with their passion, mystery, even heroism. While we don’t
know the final outcome of the implanted heart, the text shows the professionalism
of the medical team, the French national system that evidently works, sensitive
care of patients and families, and in the last pages, rituals of affirmation
for medical art and for patients.

There is
richness in de Kerangal’s style. At times it is direct, reflecting the thoughts
of characters. At times it is ornate, even baroque. She uses many images and
metaphors, often with large, epic qualities. A very long sentence about the
over-wrought parents describes them as “alone in the world, and exhaustion
breaks over them like a tidal wave” (p. 141).
The style uses many similes, often with dramatic and unexpected
comparisons. There are references to geology, astronomy, even American TV
hospital drama. The style is at times lyric…we might say “operatic.” One page about Cordélia is very, very funny.

In a
different tone, the details of medicine, law, and ethics are carefully
presented, and visual imagery puts us in the hospital rooms, the OR, and
crowded streets around a soccer game. Throughout it appears that translator Sam
Taylor has done an admirable job.

The text
invites us to consider large visions of wholeness. All the major characters seek
some comprehensive unity to their lives, and they avoid orthodoxies such as
religion, patriotism, and economic gain. Sean has his Polynesian heritage and
boat-building passion, which he has shared with Simon. Cordélia, at 25, is an
excellent nurse, wise beyond her years in some ways, but is as dazzled by a man as any teenaged girl. Nurse Rémige has his master’s in philosophy, loves
the song of rare birds, and is, himself, a serious singer.

This memoir of a life in medicine takes the writer from
St. Louis to a Navajo reservation to Central America to the east coast and from
urban hospitals to ill-equipped rural clinics. It offers a wide range of
reflections on encounters with patients that widen and deepen his sense of
calling and understanding of what it means to do healing work. He learns to listen to tribal elders, to
what children communicate without words, to worried parents, and to his own
intuition while calling on all the skills he acquired in a rigorous medical
education. Always drawn to writing,
Volck takes his writing work (and play) as seriously as his medical practice, and
muses on the role of writing in the medical life as he goes along.

Paul Kalanithi, diagnosed with stage IV metastatic lung
cancer when he was a neurosurgery resident at Stanford University, was faced
with a decision. Should he truncate his career in neurosurgery in order to
become a writer - a career he had always envisioned for himself after completing
a couple of decades of neurosurgery practice? Married to Lucy Kalanithi, an
internist he had met in medical school, Paul’s career and future had looked
bright and promising. But as he entered his final year of a seven-year
residency, symptoms of excruciating back
pain and significant weight loss began. Garbed in a hospital gown, he examines
his own CT scan – this is how we meet Paul at the beginning of the Prologue. He
then writes of the relatively brief period of misdiagnosis prior to the CT scan. With the initial negative plain x-rays, he is started on nonsteroidal
anti-inflammatory drugs. But breakthrough pain and continued weight loss leads
to the CT. Paul the physician understands the death sentence the images
portend; Paul the patient is just beginning his journey. The diagnosis and
treatment cause him to reassess his decisions about his life, to decide to
father a child even though he knows he will never see the child grow up, and ultimately
to write a memoir, essentially for his daughter.

Paul had graduated from Stanford with undergraduate and
master’s degrees which reflected his dual love of literature and science. He combined these in a second master’s degree from Cambridge
University in the history and philosophy of science and medicine before
attending Yale for his medical degree. He and his wife return
to California for residencies. The book is largely a blend of his dual
interests: a deep and abiding love and faith in literature and how words can
reveal truths, and a passion for the practice and science of neurosurgery. The rupture of fatal illness into his life interrupts his dogged trajectory
towards an academic medical career, and, like all ruptures, confounds expectations and reorients priorities.

The book has five parts: a foreword by physician-writer
Abraham Verghese, who notes the stunning prose Paul produced for an initial
article in The New York Times and exhorts the reader to “Listen to Paul” (page
xix); a brief prologue; two parts by Paul Kalanithi (Part I: In Perfect
Health I Begin, and Part II: Cease Not till Death); and a stunning,
heart-breaking epilogue by Lucy Kalanithi. In the epilogue, written with as
many literary references and allusions as her husband’s writing includes, Lucy
provides the reader with a gentle and loving portrait of her husband in his
final days, reaffirms his joy in their daughter Cady, and chronicles how she
kept her promise to her dying husband to shepherd his manuscript into print.

The bulk of the book is memoir – a childhood in Arizona and
an aversion to pursuing a life in medicine due to his hard-working cardiologist-father,
experiences at Stanford which eventually led him to reverse his decision to
avoid a medical career, the stages of his medical career and caring for
patients, and his devastating cancer. Though initially responsive to
treatment—and indeed, the treatment enables him to complete his residency and
decide to father a child with Lucy—the cancer is, as prognosticated from the diagnosis, fatal.

What makes this memoir so much more than an exercise in
memory and a tribute to the herculean effort to write while sapped by cancer
and its treatment, are the philosophical turns, the clear love of words and
literature, and the poignancy of the writing. He begins reading fiction and
nonfiction again: “I was searching for a vocabulary with which to make sense of
death, to find a way to begin defining myself and inching forward again. The
privilege of direct experience had led me away from literary and academic work,
yet now I felt that to understand my own direct experiences, I would have to
translate them back into language…I needed words to go forward.” (pp 148-9)
Paul’s writing ends with what is arguably some of the most
poetic prose ever written. He concludes by speaking directly to his infant
daughter: “When you come to one of the many moments in life where you must give
an account of yourself, provide a ledger of what you have been, and done, and
meant to the world, do not, I pray, discount that you filled a dying man’s days
with a sated joy, a joy unknown to me in all my prior years, a joy that does
not hunger for more and more but rests, satisfied. In this time, right now,
that is an enormous thing.” (p. 199)